COVID-19-related refractory status epilepticus with the presence of SARS-CoV-2 (RNA) in the CSF: a case report

Abstract

Amongst the neurologic complications of COVID-19 disease, very few reports have shown the presence of the virus in the cerebrospinal fluid (CSF). Seizure and rarely status epilepticus can be associated with COVID-19 disease. Here we present a 73-year-old male with prior history of stroke who has never experienced seizure before. He had no systemic presentation of COVID-19 disease. The presenting symptoms were two consecutive generalized tonic-clonic seizures that after initial resolution turned into a nonconvulsive status epilepticus despite antiepileptic treatment (a presentation similar to NORSE (new-onset refractory status epilepticus)). There was no new lesion in the brain magnetic resonance imaging (MRI). The CSF analysis only showed an increased protein levels and positive reverse transcription polymerase chain reaction (RT-PCR) of 2019-nCoV. Patient recovered partially after anesthetic, IVIG, steroid, and remdesivir. To our knowledge, this is the first report of a refractory status epilepticus with the presence of SARS-CoV-2 ribonucleic acid (RNA) in the CSF.

Keywords: COVID-19; CSF; Status epilepticus.

Fig. 1

a Previous stroke in the left PCA territory with bilateral periventricular white matter lesions. b, c Left temporal cortex flair and DWI hyperintensity

Fig. 2

a There was very frequent rhythmic (more than 2.5 Hz) left temporal sharp compatible with EEG ictal pattern (starting from: F7> T3, T5)^*. b, c There was no posterior dominant rhythm. There was continuous left temporal sharp/periodic lateralized epileptiform discharge (PLED)/EEG ictal pattern (maximum potential: T3, T5) and independent frequent right occipital sharp/PLED (maximum potentialO2)^* and a continuous right temporo-occipital rhythmic and irregular delta slowing (maximum potential: O2, T6) which we assumed compatible with focal nonconvulsive status epilepticus. d After tapering the anesthetics, the background rhythm consisted of a low amplitude irregular delta, theta activity without epileptiform discharges. ^*F frontal, T temporal, O occipital